Will the Irish hospital system be able to cope?

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Susie2017

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The irish hospital system will not cope with a major outbreak. We have a limited number of ICU/HDU beds and from published literature from China around 15% of those infected are seriously ill and need intensive management including ventilatory support and or dialysis. ECMO has also been utilised for the most seriously ill and im not sure how many ECMO machines are in Ireland ?. There should be travel bans to/ from affected regions in place by now. Why are they waiting ? I see the UK public health has said this morning they may quarantine people in certain geographical areas, like what has happened in China. If you dont contain this virus then there will be much higher transmission rates. If hospitals are overwhelmed and do not have facilities for ventilation then the death rate will be higher.
 
Survival figures will be determined by ICU bed numbers and access to ECMO for those who are very seriously ill. Are there 150 ICU beds in Ireland ? I think there might be less. I'm not sure about the number of ECMO facilities. I think there is one in the Mater and one in Crumlin. Not sure if there are any others ? The Chinese have used ECMO in the most severely ill patients. Its a machine that introduces oxygen into the bloodstream when the lungs are overwhelmed. You are then weaned as pulmonary function recovers. ICU bed numbers and ECMO access will be very important for those critically ill. I hear the Italians are planning to massively increase ICU bed numbers and they already have more ICU beds per head of population than we do. I gather dialysis is also needed for the very ill and again there is little extra capacity in the system as it stands. Of course if you add in extra ICU beds assuming you find space and get equipped then you have to staff them 24/7. And that's a whole other problem. Redeployment might be an option then training would have to take place etc etc, but then you are taking staff from other wards. I don't hear journalists asking about ICU, redeployment or urgent recruitment. Instead they just keep letting the HSE repeat the same mantra about hand washing and that most people will get a mild illness which we all know at this stage. ICU will be where life and death decisions will occur. If we don't have a functioning ICU system with many more beds allocated, qualified staff in place and access to ECMO then this may not end well.
 
The Italian hospital system can't cope, at least in northern Italy. They seem to be triaging and focusing their resources on those under 65 without other serious medical complications. And even then they seem to be be at max capacity. I expect similar measures here with all the attendant tragedy that will entail.
 
I don't think it would be a good use of scarce resources to invest in a hospital system that could cope with a catastrophe like the COVID-19 epidemic on a day-to-day basis. Huge resources would be required and would only be used very,very rarely.

We would have to double or triple at least health expenditure - and we do not have the resources to do that - no country does. It would not get public approval. Even getting public approval to improve our current health system is difficult - everyone wants a better system but only as long as the other person pays the increased tax required
 
North Italy is already over run they are prioritising access to breathing equipment etc based on younger age and likelihood to survive. Reading the surgeons account they have made every post op room with ventilator an icu.

Also critical folks need to spend a long time on specialist equipment.
 
Sth like ten percent of folks that are tested and infected need critical care. Maybe 250 ICU rooms. So after 2500 infections we are overrun and health outcomes affected.

Not to mention anyone who needs ICU for anything else.
 
Reading some reports it seems as if Italy has double the number of ICU beds (13/100,000 people vs 6/100,000) compared to Ireland. One problem in Italy is that 80% of the cases are in 20% of the regions - there may be availble ICU beds in Rome etc. but they are not going to transfer patients from one place to another. So once the local/regional hospitals are overloaded the problems begin.

Of about 10,000 cases in Italy the current status is
50% Hospitalized non-ICU
10% ICU
25% Home isolation
10% Recovered
5% Dead

These raw numbers don't fit with the "80% of cases are mild" viewpoint, but it's hard to draw conclusions as people in hospital could be there solely for isolation rather than treatment, though reading the reports it seems that most people only go to the hospital when really needed. More likely there are a large number of cases that have not been tested - i.e. there could well be over 30,000 cases in total.
 
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